Category Archives: Number

Locum model for pharmacists: A quantitative research study

Andrei Șuteu-Albu, Marius Călin Cherecheș

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0052

Objective: This study aimed to explore the feasibility and impact of implementing locum pharmacist models in Romanian community pharmacies, in the context of growing workforce shortages and operational challenges in the pharmaceutical sector.
Methods: A cross-sectional survey was conducted using a 15-question structured questionnaire distributed via a national locum platform and professional forums. A total of 116 valid responses were collected. The questionnaire covered demographics, professional preferences, and financial expectations. Data were analysed using statistical software to identify correlations between variables such as professional experience, interest in locum work, and expected remuneration.
Results: Respondents represented a diverse age and experience range, with the majority having between 10 and 20 years of professional experience. Community pharmacy was the dominant area of current employment (76%). Most pharmacists reported difficulty in finding replacements during leave, particularly in rural areas. Over half expressed willingness to work locum shifts if adequately compensated, preferring hourly rates 50% to 100% higher than standard wages. Data indicated a correlation between years of experience and higher salary expectations. The study highlighted distinct professional preferences between administrative and patient-facing roles and emphasised the stress associated with excessive workloads and reduced rest periods.
Conclusions: Locum work presents a viable solution to mitigate staffing shortages in Romanian pharmacies, offering flexibility and increased earning potential for pharmacists. However, challenges such as professional isolation, inconsistency in pharmacy systems, and lack of formal support must be addressed to optimise implementation. Integration strategies and legislative clarity will be essential for the long-term success of locum models in the pharmaceutical sector.

Keywords: , , , , ,
Full text: PDF

Quantitative Real-Time PCR testing in the control of hepatitis B and C: Progress and challenges towards eradication by 2030

Iulia Patrascu

Clinical County Emergency Hospital Bistrita-Nasaud, Bistrița, Romania

DOI: 10.2478/amma-2025-0046

Worldwide, chronic hepatitis B and C infections remain a significant public health challenge, causing millions of cases of liver disease globally.
The objective of this article is to highlight the need for testing and monitoring hepatitis B and C virus infections using Real-Time PCR, as well as to analyze the implementation of strategies for the eradication of hepatitis in accordance with WHO targets for 2030.
This narrative review highlights the necessity, performance, advantages, limitations, and challenges of implementing Real-Time PCR testing in clinical practice and public health policies for hepatitis B and C.
The results show that Real-Time PCR has superior sensitivity and specificity in the early detection of active infection and monitoring of viral load, facilitating optimal therapeutic management. Serological testing retains its essential role in initial screening, identifying exposure to viruses. Vulnerable groups, including hemodialysis patients, people who inject drugs, HIV-positive patients, healthcare workers, and marginalized populations, have increased prevalence and require prioritization in testing. The main limitations reported include unequal access to PCR technology and potential technical errors. Proposed strategies for improving testing include expanding access to molecular techniques, awareness campaigns, standardization of protocols, and international collaborations to support screening and treatment.
The conclusions emphasize that integrating serological testing with Real-Time PCR and focusing on vulnerable groups are crucial for achieving the objectives.

Keywords: , , ,
Full text: PDF

C-reactive protein/albumin ratio as an early indicator of severe acute pancreatitis: A preliminary study

Crina Fofiu1,2, Alina Boeriu1, Laura Nat2

1. Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Internal Medicine Department, Bistrița Clinical County Emergency Hospital, Bistrița, Romania

DOI: 10.2478/amma-2025-0049

Objective: To evaluate the prognostic accuracy of the C-reactive protein (CRP)/albumin ratio in predicting severe acute pancreatitis (SAP) and its correlation with clinical complications.
Methods: This retrospective observational study included 40 adult patients diagnosed with acute pancreatitis between January and August 2024. Patients were categorized by severity using the Revised Atlanta Classification into moderately severe or severe groups. Laboratory data, clinical characteristics, and imaging findings were compared. Receiver operating characteristic (ROC) analysis with Youden’s Index evaluated the CRP/albumin ratio predictive performance and logistic regression identified independent predictors of SAP.
Results: The CRP/albumin ratio was significantly higher in SAP patients (median 5.0 [IQR 0.93–12.62]) compared to non-SAP (1.58 [IQR 0.28–8.6], p = 0.0187). ROC analysis showed an area under the curve (AUC) of 0.809 for the CRP/albumin ratio, superior to CRP alone (AUC 0.479) and comparable to the Ranson score (AUC 0.88). An optimal cut-off value of 4.22 provided 76.9% sensitivity and 85.2% specificity. Multivariable logistic regression identified absence of intestinal transit (p = 0.033) and splenic vein thrombosis (p = 0.026) as independent predictors of SAP. The CRP/albumin ratio correlated significantly with both these complications.
Conclusions: The CRP/albumin ratio is a valuable, non-invasive, and readily available prognostic marker for early identification of severe acute pancreatitis. Its predictive accuracy is comparable to established scoring systems and may aid in triage and clinical decision-making.

Keywords: , , ,
Full text: PDF

Challenges in the management of a preterm neonate with respiratory distress and pneumothorax: A case report

Mihaela Maria Celsie1, Manuela Cucerea2,3

1. Bistrita Emergency County Clinical Hospital, Bistrita, Romania
2. Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Neonatology Department, Mures Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2025-0048

Introduction: Pneumothorax is a potentially life-threatening complication in preterm neonates, frequently associated with respiratory distress syndrome (RDS). Prompt diagnosis and individualized respiratory support are essential to avoid invasive interventions.
Objective: To describe the successful conservative management of a preterm neonate with respiratory distress syndrome complicated by pneumothorax and congenital infection, emphasizing the role of early respiratory support and infection control.
Methods: A male infant was born prematurely with clinical signs of systemic inflammation and respiratory distress. Initial management in the delivery room included thermal stabilization, tactile stimulation, and continuous positive airway support. Blood gas analysis revealed mild mixed acidosis. Chest radiography confirmed pneumothorax and respiratory distress syndrome. The patient was managed conservatively with intratracheal surfactant (100 mg per kilogram per dose), right lateral positioning and high-frequency oscillatory ventilation, without pleural drainage.
Results: The patient responded favorably to supportive management. Respiratory status improved progressively. Oxygen requirements decreased rapidly, and the pneumothorax resolved without invasive intervention. Extubation was achieved on the second day of life, and oxygen therapy was stopped by day six. The patient remained hemodynamically stable, tolerated enteral feeding, and showed appropriate weight gain. On day seven, he was transferred to the neonatal prematurity unit for continued monitoring of growth and jaundice.
Conclusions: This case supports the safety and effectiveness of conservative management in selected preterm neonates with pneumothorax. Early surfactant administration combined with high-frequency oscillatory ventilation (HFOV) can facilitate recovery while avoiding the risks associated with pleural drainage [2]. Tailored respiratory strategies and early control of systemic infection are essential for optimizing outcomes in vulnerable neonates.

Keywords: , , ,
Full text: PDF

Polycystic ovary syndrome and infertility: A narrative review of diagnostic and therapeutic approaches

Adelina-Georgiana Vârciu1,2

1. Bistrița County Emergency Hospital, Bistrița, Romania
2. Platinia Medical Center, Bistrița, Romania

DOI: 10.2478/amma-2025-0050

Objective: To synthesize current evidence on mechanisms, diagnostic evaluation, and treatment of infertility in PCOS, with emphasis on phenotype-specific implications and integrative management.
Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science from January 2015 to March 2024. Search terms included “PCOS,” “infertility,” “phenotype,” “letrozole,” “metformin,” “gonadotropins,” and “ART.” Eligible studies involved human females aged 18–45 years, written in English, and focused on PCOS-related infertility. Randomized trials, meta-analyses, and international guidelines were critically assessed for methodological rigor and clinical relevance.
Results: PCOS accounts for 70–80% of anovulatory infertility, with marked variability across phenotypes. Phenotype A, combining hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology, carries the greatest reproductive and metabolic burden. Biomarkers such as AMH, testosterone, DHEAS, fasting insulin, and HOMA-IR improve risk stratification. Lifestyle modification restores ovulation in up to 60% of overweight patients. Letrozole is superior to clomiphene, while gonadotropins and ART are effective in resistant cases. Metformin enhances ovulatory and pregnancy outcomes in insulin-resistant women. IVF protocols using antagonists and agonist triggers improve safety by reducing ovarian hyperstimulation syndrome. Psychological comorbidities, particularly anxiety and depression, are frequent and negatively affect fertility outcomes.
Conclusion: PCOS-related infertility requires a personalized, multidisciplinary approach. Integration of phenotype-based assessment, biomarker evaluation, lifestyle intervention, and tailored reproductive strategies optimizes outcomes. Addressing metabolic and psychological dimensions further improves reproductive success and long-term health.

Keywords: , , , ,
Full text: PDF

Assessing the impact of disease on the quality of life in patients with COPD

Eugenia-Corina Budin1, Ana Coșuță2, Beatrice Maria Ianoși3, Nicolae Demenciuc3, Ana-Maria Farr1, Edith-Simona Ianosi4, Ovidiu-Simion Cotoi1

1. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Clinical County Hospital Mures, Targu Mures, Romania
4. Pneumology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0043

Objective: To evaluate the prevalence and clinical impact of psychiatric comorbidities—specifically depression, anxiety, bipolar disorder, and schizophrenia—among patients hospitalized with chronic obstructive pulmonary disease (COPD), and to examine their influence on disease progression and outcomes.
Methods: A cross-sectional study was conducted from September 2024 to May 2025 at the Pneumology Department of Mureș County Clinical Hospital. Hospitalized COPD patients were assessed using standardized psychiatric screening tools and clinical evaluations. Mixed methods were used: quantitative (PHQ-9 – Patient Health Questionnaire and SGRQ-C questionnaires – SGRQ-C – COPD-adapted Saint George Questionnaire) and qualitative (semi-structured interviews).
Results: Psychiatric comorbidities were common among the study population, with depression and anxiety being the most frequently diagnosed disorders. The PHQ-9 scores showed that the percentage of people experiencing depression is much higher than the declared prevalence. The median SGRQ-C score was 62, reflecting a major impairment in quality of life. Qualitative assessment through semi-structured interviews allowed a deepening of the doctor-patient relationship.
Conclusions: Psychiatric disorders are prevalent and clinically significant in patients with COPD yet often remain underdiagnosed and undertreated. These findings highlight the importance of routine mental health screening and the implementation of integrated care strategies that address both respiratory and psychiatric needs. Such approaches have the potential to improve overall health outcomes and quality of life in this vulnerable patient population.

Keywords: , ,
Full text: PDF

Beyond the skin: A case report of vaginal melanoma

Ana-Maria Sandu1, Oana Mirela Tiucă2, Mihai Emil Căpâlnă3, Liliana Maria Chira4, Cezara-Anca-Denisa Moldovan1, Alexandra-Maria Pop3, Silviu Horia Morariu2

1. Dermatology Department, Mureș County Hospital, Targu Mures, Romania
2. Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. First Obstetrics and Gynecology Clinic, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Pathology Department, Emergency Clinical County Hospital of Targu Mures, Romania

DOI: 10.2478/amma-2025-0045

Introduction: Vaginal melanomas account for less than 3% of vaginal neoplasms and are characterized by poor prognosis.
Case report: We present the case of a 65-year-old patient with a history of invasive breast carcinoma and BRAF-negative vaginal melanoma, showing positive immunostaining for S100, SOX-10, PRAME, and vimentin, who was referred to the Dermatology Clinic of Mureș County Clinical Hospital for an erysipelas-like skin reaction on the upper limb affected by chronic lymphedema secondary to axillary lymphadenectomy. Clinical examination revealed diffuse melanosis cutis, acanthosis nigricans, and tripe palms. The patient also exhibited stigmata of Cushing syndrome, with a recent history of systemic corticosteroid therapy. Dermoscopy was performed and revealed dark brown, well defined, round macules on the genital mucosa, while the vaginal mass exhibited dermoscopic signs suggestive of melanoma.
Conclusions: Clinical examination and dermoscopy are essential for patients with mucosal melanomas, as they can uncover details that are critical for creating a comprehensive picture.

Keywords: , , ,
Full text: PDF

Correlation between HBV viral load and other paraclinical parameters in patients with chronic hepatitis B

Silvia Donica1, Cristina Nicoleta Ciurea1,2, Mihaela-Alexandra Budianu3, Anca Cighir2, Razvan Lucian Coseriu1,2, Alexandrina Maria Bunea1, Adrian Man1,2

1. Medical Microbiology Laboratory, Mureș Clinical County Hospital, Targu Mures, Romania
2. Microbiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Epidemiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0036

Background: Hepatitis B virus (HBV) infections cause approximately 1.2 million deaths annually, mainly due to complications such as hepatocellular carcinoma and cirrhosis. The key marker used to monitor HBV viraemia and guide treatment is the viral load, often unavailable in resource-limited settings. This study aimed to identify surrogate markers predicting hepatitis viral activity, valuable in areas with limited access to molecular diagnostics.
Methods: A retrospective observational study of 178 chronic hepatitis B patients was conducted at Târgu Mureș Clinical County Hospital between April 2022 and April 2025. The dataset included demographic data, hepatitis B viral load, serological viral markers, blood counts, liver function tests and coagulation parameters. Exclusion criteria consisted of duplicate samples, as well as those with detectable viral loads but missing laboratory determinations. Univariable logistic regression was used to assess associations between abnormal serological parameters and the odds of viral DNA detectability.
Results: Altogether, 178 samples tested for hepatitis viral load were included in the final analysis. Detectable viral DNA was found in 64 (35.96%) patients. A viral load positivity was significantly associated with positive HBsAg (OR = 41.7, 95% CI: 5.50-315.70, p<0.0001), elevated AST levels (OR = 2.46, 95% CI:1.23-4.92, p=0.01), and negative HBeAb (OR = 0.3, 95% CI: 0.09-0.94, p=0.04). Other tested associations were not statistically significant.
Conclusion: HBsAg, HBeAb, and AST levels were significantly associated with hepatitis B DNA detectability, highlighting their potential use in settings lacking molecular assays. Further research with larger cohorts may help identify accessible predictors of viral replication and disease progression.

Keywords: , ,
Full text: PDF

Impact of the non-antibiotic compound vitamin C on ciprofloxacin efficacy: An in vitro study

Georgiana Mădălina Huțuțui1, Anca Cighir2

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0044

Objective: Antimicrobial resistance has become a worldwide health challenge due to antibiotic misuse; thus, there is a rising interest in repurposing non-antibiotic substances, such as vitamin C. Whether these compounds can alter antibiotic efficacy remains insufficiently investigated, especially alongside commonly used antibiotics like ciprofloxacin. This study aims to evaluate the impact of vitamin C on ciprofloxacin activity in standard bacterial strains.
Methods: Ciprofloxacin and vitamin C were assessed by checkerboard assay on six ATCC strains: methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. The research was conducted in triplicate to ascertain minimum inhibitory concentrations and calculate the fractional inhibitory concentration index (FICI). Data were summarized with means and standard deviations, classified by outcome, and analyzed with Fisher’s exact test. Figures were created using R software.
Results: For both methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, and Klebsiella pneumoniae, all combinations showed indifference (FICI range 0.83-4), while Pseudomonas aeruginosa showed one antagonistic outcome (FICI=5). In Escherichia coli, antagonism was predominant (n=9, FICI range 4.001-6), with a statistically significant reduction in complete inhibition compared to ciprofloxacin alone (p=0.037), suggesting that vitamin C reduces ciprofloxacin efficacy at higher concentrations, while synergy occurred at lower concentrations (n=4, FICI range 0.064-0.281).
Conclusions: To our knowledge, this is the first systematic checkerboard analysis of ciprofloxacin-vitamin C on multiple ATCC strains, underscoring the impact of non-antibiotic compounds. These findings are significant because they support the need for further studies on how non-antibiotic compounds may influence antibiotic therapy in patients.

Keywords: , , , ,
Full text: PDF